Infertility and spontaneous abortion

National Institute for Clinical Excellence. Fertility: assessment and treatment for people with fertility problems [Internet]. London: RCOG Press; 2004 Feb [cited 2009 March 8]. 216 p. Available from: http://www.rcog.org.uk/womens-health/clinical-guidance/fertility-assessment-and-treatment-people-fertility-problems

Key priorities for implementation

Screening for Chlamydia trachomatis

• Before undergoing uterine instrumentation women should be offered screening for Chlamydia trachomatis using an appropriately sensitive technique.

Assessing tubal damage

• Women who are not known to have co-morbidities (such as pelvic inflammatory disease, previous ectopic pregnancy or endometriosis) should be offered hysterosalpingography (HSG) to screen for tubal occlusion because this is a reliable test for ruling out tubal occlusion, and it is less invasive and makes more efficient use of resources than laparoscopy.

Intra-uterine insemination

• Couples with mild male factor fertility problems, unexplained fertility problems or minimal to mild endometriosis should be offered up to six cycles of intra-uterine insemination because this increases the chance of pregnancy.

In vitro fertilisation treatment

• Couples in which the woman is aged 23–39 years at the time of treatment and who have an identified cause for their fertility problems (such as azoospermia or bilateral tubal occlusion) or who have infertility of at least 3 years’ duration should be offered up to three stimulated cycles of in vitro fertilisation treatment.
• Human menopausal gonadotrophin, urinary follicle-stimulating hormone and recombinant follicle-stimulating hormone are equally effective in achieving a live birth when used following pituitary down-regulation as part of in vitro fertilisation treatment. Consideration should be given to minimising cost when prescribing.
• Couples should be informed that the chance of multiple pregnancy following in vitro fertilisation treatment depends on the number of embryos transferred per cycle of treatment. To balance the chance of a live birth and the risk of multiple pregnancy and its consequences, no more than two embryos should be transferred during any one cycle of in vitro fertilisation treatment.
• Embryos not transferred during a stimulated in vitro fertilisation treatment cycle may be suitable for freezing. If two or more embryos are frozen then they should be transferred before the next stimulated treatment cycle because this will minimise ovulation induction and egg collection, both of which carry risks for the woman and use more resources.